HRRET Study Consent

Pilot Test Study for the HIV Risk Reduction Educational Tool

Attachment 5: Study Consent Form

Introduction and Purpose:

You have been asked to take part in a research study. The purpose of this study is to learn your opinions about HIV prevention materials developed by the Centers for Disease Control and Prevention (CDC). RTI International, a nonprofit research organization in North Carolina, is conducting this CDC-sponsored study.

Procedures:

You will be asked to complete a brief survey so that we can learn more about you. After you complete the survey, you will be asked to review an online HIV prevention tool developed by CDC. You will then be asked to complete another brief survey so that we can learn your opinions about the online tool. The study will take about 45 minutes to complete.

Risk/Discomforts and Right to Refuse or Withdraw:

You might feel embarrassed or upset by some of the survey questions that ask about sexual behavior and alcohol and drug use or by the content of the tool. You can decline to answer any questions for any reason. You can also stop reviewing the tool (click the “Quit Exploring” button) or participating in the study (click the “Quit Study” button) at any time.

Benefits:

There is no direct benefit to you for being in this study. However, you may learn more about ways to prevent getting or giving someone else HIV.

Privacy:

Your responses will be kept private to the extent allowable by law. The survey does ask you for your email address. The survey vendor will send you a reminder email to complete the study if you stop participating before you finish the posttest survey. The survey vendor will also record participants’ IP addresses to help make sure people do not complete the study more than once. Email and IP addresses will be destroyed after all of the data are collected. Only the survey vendor will know your email and IP address; neither RTI nor CDC will have access to this information. This means that RTI and CDC cannot link your survey answers to you as an individual.

To help protect your privacy, we suggest that you participate in the study in a private location – either in your home and/or in a room with a door. Please also close your browser window once you are finished.

Token of Appreciation:

We will give you a $25 Amazon gift card as a token of appreciation. Instructions for redeeming the gift card will be provided after you complete the second survey.

Persons to Contact:

If you have questions about the study, you can call Jennifer Uhrig at 1-800-334-8571, extension 3311. She can be reached between 9 a.m. and 5 p.m., Eastern Standard Time, Monday–Friday. If you have questions about your rights as a participant, you can call RTI’s Office of Research Protection toll-free at 1-866-214-2043.

If you have any questions about HIV, including how to locate services and ways to protect yourself, please contact CDC Info (http://www.cdc.gov/cdc-info/). To find local HIV testing sites, health centers, and other service providers, you can also visit AIDS.gov (http://locator.aids.gov/).

Consent:

Please choose one to continue with the study:

□ I have read this consent form and agree to participate in the study.

□ I have read this consent form and do not want to participate in the study.

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